A Phenomenological Exploration of the Experience of Antepartum Bed Rest in Mothers: Beyond Postpartum
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Background APBR in high- risk pregnancies such as premature rupture of membranes, pre-eclampsia, preterm labor, and advanced cervical dilation/effacement is the current prescription for the prevention of preterm birth. This prescription of bed rest is practiced by 71-81 percent of United States Obstetricians (Maloni, 2012). The current preterm birth rate remains high at 11.4 percent (World Health Organization, 2014 [WHO]).
The March of Dimes Prematurity Campaign aims to reduce preterm birth rates across the United States. Premature Birth Report Card grades are assigned by comparing 2014 preterm birth rate in a state or locality to the March of Dimes goal of 8.1 percent by 2020. This will inevitably increase the number of women who are prescribed APBR. Pregnant women who are at risk of delivering a preterm infant are hospitalized and placed on bed rest. Current evidence demonstrates that prolonged tome on bed rest can have physical as well as psychosocial effects (Maloni, 2012). APBR as a treatment is based on the assumption that it is both safe and effective (Maloni, 2011). However current evidence based research indicates that bed rest treatment is ineffective in preventing preterm birth (Maloni, 2011). Psychologically, AP patients hospitalized on bed rest report higher feelings of anxiety and depression ( Dunn, Handley, & Shelton, 2007). Physiological side effects include muscle atrophy, bone loss, and maternal weight loss (Maloni, 2011). Despite the questions regarding the effectiveness of APBR, as well as the negative psychological and physiological consequences, it is still widely practiced in the United States and Canada. Although there is no other therapeutic alternative, APBR is offered by physicians as a natural inclination that doing something is better than doing nothing (Biggio, 2013).
Few Qualitative as well as Quantitative studies are done on the experience of APBR as it relates to the patient when they are in the hospital. However, a limited number of studies are done on how it affects the mother in the postpartum period. In fact, no studies exist on the effects of APBR on the mother who has surpassed the postpartum six week period. This gap in the literature warrants investigating, as the negative long term effects of APBR may surpass the postpartum period for some mothers. These mothers may be feeling isolated as routine postpartum checkups have ceased. There is no research into this untreated time period to inform us of how these mothers feel about the experience.
Purpose The purpose of this study is to explore the long-term effects of APBR from the perspective of the mother who has delivered and transitioned into the home environment. The current state of the science of ante partum bed rest (APBR) provides inadequate articulation of it's long term effects. This research, using a qualitative interpretive phenomenological approach, seeks to discover meaning and extrapolate themes from semi-structured interviews with mothers who have had the experience of APBR.
Philosophical Underpinnings The qualitative phenomenological framework used for this study is Heidegger’s Interpretive Phenomenology , which will study the first person’s point of view. This research project will explore this from the perspective of the mother, as she interprets the meaning of her experience of APBR. This approach seeks to understand the person’s reality, opinions, beliefs, knowledge, and questions pertaining to an experience (Schultz & Cobb-Stevens, 2004).
Methods Van Manen’s Thematic Analysis will be used to interpret this research as Van Manen states a person cannot reflect on the lived experience until afterwards and this reflection is always retrospective ( Van Manen, 1990). This qualitative framework of interpretive phenomenology provides a lens that allows discovery of essence and personal meaning from the participants’ individual experiences ( Holloway & Wheeler, 2002). A purposeful sample of 10-20 mothers who have had the experience of hospitalized APBR and surpassed the six week postpartum period will be studied. One on one semi structured interviews using open ended questions are used, tape recorded, and professionally transcribed verbatim. Recruitment will be used via flyers in doctors’ offices, churches, community clinics, and perinatal clinics. Inclusion criteria include women who are 18 years or older, can speak read, and write English, were diagnosed with a high-risk pregnancy and prescribed APBR weeks and maintained hospitalized bed rest at a minimum of 14 days just prior to giving birth and have surpassed the postpartum period of 6 weeks .
Nursing Implications Ways of Knowing Evidence based practice efforts today are what currently drive changes in nursing. The support of research materials that are narrative and subjective are qualitative studies of human experiences. The results of this research study can be used to improve patient outcomes by providing insights into patient needs in treatment and interaction with health professionals; evaluate programs and treatments, gain understanding of health professionals roles and identities; examine the perception and efficacy of professional education; and obtain perspectives on community and public health issues. The nursing implications for nursing science are that this study has the potential to be further researched using different inclusion criteria and populations. This informs nursing practice and provides education of nurses via changes made in nursing administration and leadership through policy changes